Tanning in body dysmorphic disorder

The color of skin: psychiatric ramifications

Skin color is one of the major attributes that defines both individual distinctiveness and differences between groups. There is a preference for lighter skin world-wide, among both light- and dark-skinned individuals, further leading to skin-color bias based upon skin-color hierarchy within certain ethnoracial groups. The psychiatric and psychosocial ramifications of skin color are important in several situations, including (1) disorders of skin discoloration (eg, vitiligo), which can significantly affect the psychosocial development of the patient especially when it has its first onset during adolescence; (2) widespread use of skin-lightening products, which are used despite knowledge about serious toxicity from inorganic mercury and potent corticosteroids that are some of their main constituents; (3) indoor tanning, which is a recognized carcinogen and practiced by over 50% of university-age adults and 20% of adolescents. Educating about photocarcinogenicity does not change tanning behaviors, which is strongly driven by peer pressure; and (4) when a psychiatric disorder, such as body dysmorphic disorder or major depressive disorder, is the primary basis for skin color dissatisfaction. Despite the role of complex sociocultural and psychiatric factors in clinical manifestations involving skin color, a supportive relation with the dermatologist can significantly aid the patient in managing their disease burden.

Prevalence of Tanning Addiction and Behavioral Health Conditions among Ethnically and Racially Diverse Adolescents

Evidence indicates that tanning may be addictive and is associated with other behavioral health conditions. Few studies have examined tanning addiction among adolescents. We performed a cross-sectional study to explore the relationship between tanning addiction, substance use, and psychological conditions among a racially and ethnically diverse adolescent population. Tanning addiction was assessed using the modified CAGE measure among 11th grade students in Los Angeles (N = 2,637; response rate 78%). Overall, 7.02% of the sample met tanning addiction criteria. Tanning addiction was significantly associated with past 30-day smoking and marijuana use, problem substance use, depression, panic disorder, obsessive-compulsive disorder, and bipolar disorder in regression models. After controlling for all significant substance use and psychological variables, we found that problem marijuana use and obsessive-compulsive disorder remained significantly associated with tanning addiction (odds ratio = 2.06 [95% confidence interval = 1.03-4.09] and odds ratio = 2.54 [95% confidence interval = 1.73-3.72], respectively.) Tanning addiction was also significantly associated with multiple problem substance use and behavioral health conditions. Our findings indicate an appreciable prevalence of tanning addiction among ethnically and racially diverse adolescents and suggest the importance of addressing tanning addiction in the context of comorbid behavioral conditions to reduce this high-risk behavior among diverse youth.

Review of interventions to reduce ultraviolet tanning: Need for treatments targeting excessive tanning, an emerging addictive behavior

Millions of Americans engage in tanning each year, defined as intentional ultraviolet radiation (UVR) exposure in the form of sunbathing or the use of indoor tanning beds. An emerging body of research suggests that UVR has addictive properties and some tanners engage in excessive tanning. This article provides an overview of the evidence of tanning addiction and a systematic review of existing tanning interventions with the goal of evaluating their potential to impact addicted tanners. Our search identified 24 intervention studies that were summarized and discussed according to 3 primary themes. First, there is a dearth of tanning interventions that target excessive tanning or are designed as treatments for tanning addiction. Second, tanning interventions are primarily educational interventions designed to increase knowledge of the risks of tanning. Third, there are notable aspects of existing tanning interventions that are relevant to addiction science, including the use of brief motivational and cognitive-behavioral-based interventions. Future directions are considered including recommendations for utilizing the existing evidence base to formulate interventions targeting excessive tanners. (PsycINFO Database Record

Body image disturbance and skin bleaching

This study looks at body image disturbance among Jamaicans who bleach their skin. The hypothesis states that there is a positive relationship between skin bleaching and body image disturbance. The study used a convenience sample of 160 participants with a skin bleaching group (n = 80) and a non-bleaching comparison group (n = 80). The instrument included demographic questions, the body image disturbance questionnaire (BIDQ), and questions about skin bleaching. The results of a t-test revealed that the skin bleaching group (M = 1.5255, SD = 0.42169) was not significantly different from the non-bleaching group (M = 1.4938, SD = 0.74217) in terms of body image disturbance, t(158) = 0.333, p = .740. The participants who bleached did not suffer from body image disturbance. Self-reports revealed that they bleached to acquire beauty, attract a partner, elude the police, and market skin bleaching products. The practice was fashionable and popular and it made some participants feel good, while others were fans of a popular musical artiste who bleached his skin. The majority of participants bleached because of the perceived personal, social, and entrepreneurial benefits of the practice and not because they suffered emotional distress, anxiety, and functional impairment because of their skin colour. However, there was some level of BID among the minority of participants who argued that they bleached because they wanted to be pretty so they were emotionally distressed about there body image and experienced functional impairment.

Mood Changes After Indoor Tanning Among College Women: Associations with Psychiatric/Addictive Symptoms

Indoor tanning (IT) has been linked with psychiatric and addictive symptoms, and frequent tanning may indicate tanning dependence (addiction). The current study evaluated the effects of an IT episode on mood states and the association of these effects with psychiatric and addictive symptoms among young adult female indoor tanners. One-hundred thirty-nine female university students aged 18-25 years who had indoor tanned completed an online survey including the Positive and Negative Affects Scales and a standardized psychiatric interview (the MINI International Neuropsychiatric Interview) via telephone. Psychiatric and addictive symptoms were relatively common among these young adult female indoor tanners. Overall, participants reported significant decreases in both negative (upset, scared, irritable, nervous, jittery, afraid) and positive (feeling interested) mood states after their most recent tanning episode. Multivariable linear regression analyses showed that more frequent indoor tanning in the past month and symptoms of illicit drug use disorders were associated with decreases in negative mood, and symptoms of generalized anxiety disorder were associated with a decrease in feeling interested. In summary, indoor tanners report relatively high rates of psychiatric and substance use symptoms, including symptoms of tanning dependence, and indoor tanning appears to alter mood. Women with certain substance use and psychiatric characteristics may be more vulnerable to such mood changes after tanning indoors. Further research is needed to clarify the relationships among these variables.

The association of tanning behavior with psycho-tropic medication use among young adult women

Despite its known association with skin cancer, tanning remains popular among young adult women. Indoor tanning behavior has been found to be associated with affective and addictive disorders. To better understand potential psychological and biological mechanisms of tanning behavior, we investigated associations between tanning and medication (psychotropic and other) use among young women. Two hundred and fifty-three women age 18-29 years old were recruited from two northeastern university campus communities. Women self-reported tanning frequency and chronic medication use. In both univariate and multivariate analyses, indoor tanning ≥12 times last year was significantly associated with use of psychotropic medication and anti-depressants in particular. Sunbathing was not associated with medication use. Potential reasons for associations between tanning and psychotropic medication use are discussed. Indoor tanners should be warned that some psychotropic medications are photosensitizing, thus increasing risk for burns and other skin damage from indoor tanning.

Fostering multiple healthy lifestyle behaviors for primary prevention of cancer

The odds of developing cancer are increased by specific lifestyle behaviors (tobacco use, excess energy and alcohol intakes, low fruit and vegetable intake, physical inactivity, risky sexual behaviors, and inadequate sun protection) that are established risk factors for developing cancer. These behaviors are largely absent in childhood, emerge and tend to cluster over the life span, and show an increased prevalence among those disadvantaged by low education, low income, or minority status. Even though these risk behaviors are modifiable, few are diminishing in the population over time. We review the prevalence and population distribution of these behaviors and apply an ecological model to describe effective or promising healthy lifestyle interventions targeted to the individual, the sociocultural context, or environmental and policy influences. We suggest that implementing multiple health behavior change interventions across these levels could substantially reduce the prevalence of cancer and the burden it places on the public and the health care system. We note important still-unresolved questions about which behaviors can be intervened upon simultaneously in order to maximize positive behavioral synergies, minimize negative ones, and effectively engage underserved populations. We conclude that interprofessional collaboration is needed to appropriately determine and convey the value of primary prevention of cancer and other chronic diseases.

Psychometric assessment of the craving to tan questionnaire

BACKGROUND

Researchers and clinicians suggest that excessive tanning may be a behavioral addiction. Given the significance of craving in substance use, craving may be a useful construct to assess in those who tan.

OBJECTIVE

We designed this study to assess the psychometric properties of an alcohol craving measure adapted to measure past-week craving to tan.

METHODS

Undergraduate students (n = 421) who reported past-month tanning completed a battery of questionnaires that assessed demographics, tanning-related characteristics, and psychopathology, in addition to the Craving to Tan Questionnaire (CTQ).

RESULTS

Analyses provided support for a single factor CTQ with good internal consistency, construct validity and convergent validity. CTQ scores were significantly higher among problematic versus non-problematic and dependent versus non-dependent tanners. CTQ scores were also associated with several tanning-related characteristics, such money spent on tanning in a typical month, frequency of tanning, and frequency of tanning-related problems. Additional analyses found that past-week craving to tan was significantly associated with greater obsessive compulsive and body dysmorphic symptoms.

CONCLUSIONS

It may be useful in clinical settings to identify those experiencing problems with tanning and in research to further clarify the conceptualization of addiction-like tanning. However, the CTQ needs further evaluation.

Phenomenology and psychopathology of excessive indoor tanning

Excessive indoor tanning, defined by the presence of an impulse towards and repetition of tanning that leads to personal distress, has only recently been recognized as a psychiatric disorder. This finding is based on the observations of many dermatologists who report the presence of addictive relationships with tanning salons among their patients despite being given diagnoses of malignant melanoma. This article synthesizes the existing literature on excessive indoor tanning and addiction to investigate possible associations. This review focuses on the prevalence, clinical features, etiology, and treatment of this disorder. A literature review was conducted, using PubMed, Google Scholar, EMBASE and PsycINFO, to identify articles published in English from 1974 to 2013. Excessive indoor tanning may be related to addiction, obsessive-compulsive disorder, impulse control disorder, seasonal affective disorder, anorexia, body dysmorphic disorder, or depression. Excessive indoor tanning can be included in the spectrum of addictive behavior because it has clinical characteristics in common with those of classic addictive disorders. It is frequently associated with anxiety, eating disorders, and tobacco dependence. Further controlled studies are required, especially in clinical psychopathology and neurobiology, to improve our understanding of excessive indoor tanning.

Tanning addiction and psychopathology: Further evaluation of anxiety disorders and substance abuse

BACKGROUND

Little research has investigated the correlates of problematic tanning and tanning dependence.

OBJECTIVE

We sought to identify characteristics associated with problematic tanning and tanning dependence, and to evaluate simultaneously the associations of variables as correlates of problematic tanning and tanning dependence.

METHOD

To assess tanning-related characteristics, psychopathology, and demographics, we administered questionnaires to 533 tanning university students; 31% met criteria for tanning dependence, 12% for problematic tanning.

RESULTS

Both problematic tanning and tanning dependence were significantly associated with being female (P < .001 and P < .001, respectively) and with screening positive on measures of obsessive-compulsive (P < .001 and P = .005, respectively) and body dysmorphic (P = .019 and P < .001, respectively) disorders. Frequency of tanning in the past month was the strongest correlate of problematic tanning (P < .001) and tanning dependence (P < .001) when included in a model that controlled for shared variance among demographics and psychopathology.

LIMITATIONS

The sample was recruited from 1 university and contained only self-report measures.

CONCLUSION

Results suggest that many who engage in excessive tanning may also have significant psychiatric distress. Additional research is needed to characterize compulsive, problematic tanning and its rates, correlates, and risk factors among diverse samples.

Measurement of tanning dependence

BACKGROUND

Indoor tanning has been found to be addictive. However, the most commonly used tanning dependence measures have not been well validated.

OBJECTIVE

The study's purpose was to explore the psychometric characteristics of and compare the modified Cut-down, Annoyed, Guilty, Eye-opener Scale (mCAGE), modified Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition - Text Revised (mDSM-IV-TR) and Tanning Pathology Scale (TAPS) measures of tanning dependence and provide recommendations for research and practice.

METHODS

This study was a cross-sectional online survey with 18- to 25-year-old female university students. The main outcome variable was tanning dependence measured by the mCAGE, mDSM-IV-TR and TAPS.

RESULTS

Internal consistency of the TAPS subscales was good but was poor for the mCAGE and mDSM-IV-TR, except when their items were combined. Agreement between the mCAGE and mDSM-IV-TR was fair. Factor analysis of the TAPS confirmed the current four-factor structure. All of the tanning dependence scales were significantly correlated with one another. Likewise, most of the tanning dependence scales were significantly correlated with other measures of tanning attitudes and behaviours. However, the tolerance to tanning TAPS subscale was not significantly correlated with any measure of tanning attitudes or behaviours and had the lowest subscale internal reliability and eigenvalues.

CONCLUSION

Based on the data and existing literature, we make recommendations for the continued use of tanning dependence measures. Intervention may be needed for the approximately 5% of college women who tend to be classified as tanning dependent across measures. Monitoring of individuals reporting tanning dependence symptoms is warranted.

Psychiatric and addictive symptoms of young adult female indoor tanners

PURPOSE

Indoor tanning (IT) increases risk for melanoma and is particularly common among young adult women. IT has also been linked with some psychiatric symptoms, and frequent tanning may indicate tanning dependence (addiction) associated with endorphin release during ultraviolet radiation exposure. The objective of the current study was to investigate associations between IT, tanning dependence, and psychiatric and substance use symptoms in young adult women.

DESIGN

Cross-sectional survey and psychiatric interview.

SETTING

Online, except for the Mini International Neuropsychiatric Interview (MINI), which was completed over the telephone.

SUBJECTS

Participants were 306 female university students aged 18 to 25 years.

MEASURES

MINI, Seasonal Scale Index, tanning dependence scales, reporting ever having used a tanning bed or booth with tanning lamps (single item), reporting smoking a cigarette in the last 30 days (single item).

ANALYSIS

Descriptive statistics, χ(2) analysis, multivariate logistic regression.

RESULTS

Forty-six percent of the sample reported a history of IT, and 25% were classified as tanning dependent. Multivariate logistic regression analyses showed that IT was significantly associated with symptoms of alcohol use disorders, generalized anxiety, and not having social anxiety. Tanning dependence was associated with symptoms of alcohol use disorders.

CONCLUSION

Tanning is of concern not only for its association with skin cancer but for its association with psychiatric and substance use symptoms. Young women with certain psychological problems may seek relief from their symptoms by IT. These findings suggest that indoor tanners may benefit from health behavior and other psychosocial interventions.

Activation of the mesostriatal reward pathway with exposure to ultraviolet radiation (UVR) vs. sham UVR in frequent tanners: a pilot study

Frequent and excessive tanning persists despite a growing understanding of its associated morbidity and mortality, suggesting that ultraviolet radiation may impart rewarding effects beyond the assumed cosmetic benefits. To empirically measure putative centrally rewarding properties of ultraviolet radiation (UVR), we assessed the effects of a commercially available tanning bed upon regional cerebral blood flow (rCBF), a measure of brain activity, using single-photon emission computed tomography (SPECT). Seven frequent salon bed tanners were placed under a UVA/UVB tanning light during two sessions; one session with UVR and the other with filtered UVR (sham UVR). Session order was randomized and subjects were blinded to study order. During the UVR session, relative to sham UVR session, subjects demonstrated a relative increase in rCBF of the dorsal striatum, anterior insula and medial orbitofrontal cortex, brain regions associated with the experience of reward. These changes were accompanied by a decrease in the subjective desire to tan. These findings suggest that UVR may have centrally rewarding properties that encourage excessive tanning.

Correlates of sunscreen use among high school students: a cross-sectional survey

Background

Adolescents put themselves at risk of later skin cancer development and accelerated photo-aging due to their high rates of ultraviolet radiation exposure and low rates of skin protection. The purpose of the current study was to determine which of the Integrative Model constructs are most closely associated with sunscreen use among high school students.

Methods

The current study of 242 high school students involved a survey based on the Integrative Model including demographic and individual difference factors, skin protection-related beliefs and outcome evaluations, normative beliefs, self-efficacy, sunscreen cues and availability, intentions, and sunscreen use. Our analyses included multiple linear regressions and bootstrapping to test for mediation effects.

Results

Sunscreen use was significantly associated with female gender, greater skin sensitivity, higher perceived sunscreen benefits, higher skin protection importance, more favorable sunscreen user prototype, stronger skin protection norms, greater perceived skin protection behavioral control, and higher sunscreen self-efficacy. Intentions to use sunscreen mediated the relationships between most skin protection-related beliefs and sunscreen use.

Conclusions

The current study identified specific variables that can be targeted in interventions designed to increase sunscreen use among adolescents.

[Body dysmorphic disorder (BDD)]

OBJECTIVE

Body Dysmorphic Disorder (BDD) has replaced the old and ill-defined concept of dysmorphophobia since its introduction as a full-blown disorder in DSM-III-R in 1987. Since then, the body of knowledge on BDD has considerably increased. At the same time, cosmetic medicine and surgical procedures, for which the indications and outcomes of BDD should be taken into account, have become common. Hence, we decided to undertake a review of the literature on BDD aimed at French speaking practitioners.

METHOD

We searched Medline for the literature on BDD and dysmorphophobia in English and in French and made a critical examination of findings resulting from those studies where the methodology was sound.

RESULTS

BDD is frequent in the general population with a point prevalence between 1.7 and 2.4% and often severe. Delusive and non-delusive forms of BDD likely belong to the same entity and both respond to the same treatment. Serotonin reuptake inhibitors and cognitive behavioral therapies have demonstrated their efficacy in randomized controlled studies. Esthetic, medical and surgical treatments, which are very often sought after by BDD patients, have been shown to be ineffective and potentially harmful.

DISCUSSION

Our review confirms the progress in knowledge on BDD. The most interesting results concern clinical characteristics, epidemiology in the general population, and treatment. The prevalence of BDD in the general population should prompt every practitioner to take this disorder into account when faced with the increasing demand for medical and surgical cosmetic procedures. Nevertheless, further research is needed, particularly on the demand of non psychiatric treatments by BDD patients and the way medical or surgical specialists manage it.

Addictive-like behaviours to ultraviolet light among frequent indoor tanners

BACKGROUND

Frequent, purposeful exposure to ultraviolet (UV) light may induce a compulsive desire to tan despite the negative consequences being known, suggesting a behavioural complex similar to addictive disorders.

AIM

To assess the presence of addictive-like behaviours in subjects using indoor tanning salons.

METHODS

Subjects (n = 100) were surveyed by two questionnaires: a modified CAGE questionnaire to assess behaviours consistent with problem tanning and a modified Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) ('substance dependence' criteria) to assess behaviours consistent with a dependence-like disorder.

RESULTS

In total, 41% of subjects met criteria consistent with a 'tanning addictive disorder', and an additional 33% met criteria for problematic tanning behaviour based on the modified CAGE criteria or subthreshold criteria on the modified DSM-IV criteria. Female gender and early age of onset were associated with meeting tanning addiction criteria.

CONCLUSION

A high percentage of subjects who tan frequently in indoor salons experience behaviours and consequences to their tanning consistent with other identified addictive disorders.

Tanning as a behavioral addiction

BACKGROUND

Persistent tanning despite potentially fatal consequences suggests a compulsive behavior similar to other addictive disorders.

OBJECTIVES

To review the literature supporting tanning addiction from an epidemiological, behavioral, and neurobiological perspective.

METHODS

A comprehensive review of the medical literature was conducted to assess the health consequences of tanning, behaviors and other psychiatric disorders associated with tanning, and central rewarding effects of ultraviolet light.

RESULTS

Many frequent tanners endorse signs and symptoms adapted from Diagnostic and Statistical Manual-IV (DSM IV) substance abuse or dependence criteria. Recent studies suggest biochemical mechanisms may reinforce ultraviolet light seeking behavior.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Frequent and persistent tanning may reveal itself to be a dermatologic-psychiatric disorder with carcinogenic sequelae. Multidisciplinary studies are required to determine the validity of an addiction diagnosis and to explore pharmacologic and cognitive therapeutic options for affected persons.

[An old "new" disease: body dysmorphic disorder (dysmorphophobia)]

Body dysmorphic disorder causes significant suffering and serious impairment in psychosocial functions. However, this disease with dangerous risks is scarcely mentioned in the Hungarian medical literature. The objective of the author is to give a detailed review about this almost unknown, but relatively common disorder. The serious disorder of body perception is in the centre of symptoms, leading to social isolation, anxiety, depression and obsessive-compulsive phenomena. The disorder often remains unrecognized because of the lack of insight of disease. Comorbidity with affective disorders, anxiety disorders, personality disorders, eating disorders, alcoholism and substance use disorders is common. The life quality of affected patients is bad, the risk of suicide or violence is high. Biological, psychological and sociocultural factors play an important role in the etiopathogenesis of the disorder. Imaging techniques and neuropsychological measures revealed changes characteristic for the disease. Childhood abuse and neglect, appearance-related critical remarks, stressors and the impact of media are also supposed to have role in the development of the disorder. The point prevalence is 0.7-2.5% in the general population, however, in special groups such as in tertiary students, psychiatric, dermatological and cosmetic surgery patients the prevalence rates may be much higher. Typically, the disease begins in early adolescence, and it persists and deteriorates without treatment, showing a chronic course. By means of pharmacotherapy and/or psychotherapy long-during improvement or full recovery can be achieved within a relatively short period of time.

Body dysmorphic disorder

Body dysmorphic disorder (BDD) is a relatively common disorder that consists of a distressing or impairing preoccupation with imagined or slight defects in appearance. BDD is commonly considered to be an obsessive-compulsive spectrum disorder, based on similarities it has with obsessive-compulsive disorder. It is important to recognize and appropriately treat BDD, as this disorder is associated with marked impairment in psychosocial functioning, notably poor quality of life, and high suicidality rates. In this review, we provide an overview of research findings on BDD, including its epidemiology, clinical features, course of illness, comorbidity, psychosocial functioning, and suicidality. We also briefly review recent research on neural substrates and cognitive processing. Finally, we discuss treatment approaches that appear efficacious for BDD, with a focus on serotonin-reuptake inhibitors and cognitive-behavioral therapy.

Excessive tanning: some psychopathological explanations

Excessive tanning appears to be evident in about one quarter of regular sunbathers. Susceptible individuals are likely to be young Caucasians from Western societies. Despite ongoing education by the media to the public about the risks of excessive exposure to ultraviolet radiation and the availability of potent sunscreens, there seems to be a concurrent proliferation of tanning facilities. What might be potential psychological explanations for excessive or pathological tanning? Psychopathological explanations may exist on both Axes I and II and include substance use, obsessive-compulsive, body dysmorphic, and borderline personality disorders. While there is no known treatment for pathological sunbathing, we discuss several treatment interventions from the literature that have been successfully used for the general public.

Body dysmorphic disorder

Body dysmorphic disorder (BDD) is a relatively common disorder that consists of a distressing or impairing preoccupation with imagined or slight defects in appearance. BDD is commonly considered to be an obsessive-compulsive spectrum disorder, based on similarities it has with obsessive-compulsive disorder. It is important to recognize and appropriately treat BDD, as this disorder is associated with marked impairment in psychosocial functioning, notably poor quality of life, and high suicidality rates. In this review, we provide an overview of research findings on BDD, including its epidemiology, clinical features, course of illness, comorbidity, psychosocial functioning, and suicidality. We also briefly review recent research on neural substrates and cognitive processing. Finally, we discuss treatment approaches that appear efficacious for BDD, with a focus on serotonin-reuptake inhibitors and cognitive-behavioral therapy.

A preliminary investigation of the predictors of tanning dependence

OBJECTIVES

To investigate possible predictors of tanning dependence including demographic variables, exposure and protective behaviors, and other health-related behaviors.

METHODS

This study consisted of an online survey of 400 students and other volunteers from a university community.

RESULTS

Twenty-seven percent of the sample was classified as tanning dependent. Tanning dependence was predicted by ethnicity and skin type, indoor and outdoor tanning and burning, and lower skin protective behaviors, as well as smoking and body mass index.

CONCLUSIONS

Young adults are at risk for tanning dependence, which can be predicted by specific demographic and behavioral variables.

Update on sun protection and tanning in children

PURPOSE OF REVIEW

In this article we examine the latest information regarding pediatric sun protection and specifically focus on the impact of indoor tanning on children.

RECENT FINDINGS

We examine and discuss the prevailing views and trends on ultraviolet radiation exposure, sun protection and the attendant adverse health effects among children. We identify the challenges related to limiting ambient ultraviolet exposure in children. As children, particularly adolescents, gain an understanding of sun protection, their use of ultraviolet radiation protection does not increase concordantly. We discuss health policies regarding ultraviolet radiation protection, compliance with these policies and potential methods to increase compliance. We also examine addiction-like behavior and other psychosocial factors affecting those who are regular indoor tanners. Finally, we consider possible alternatives to ultraviolet radiation induced tanning and whether encouraging these options leads to a confusing, mixed message from healthcare providers.

SUMMARY

In this article we examine and discuss current practices, attitudes and recent trends in sun protection. We discuss indoor tanning, with special emphasis on the potential addictive qualities of ultraviolet radiation. Our goal is to identify opportunities and future directions to promote sun safety and protect children from harmful ultraviolet radiation exposure.